Most patients can be referred when the permanent teeth are first established. Find out more about the important occasions when this is not the case.

Types of occlusal problem to refer in the deciduous dentition:

  • Individuals with cleft lip and/or palate, or other craniofacial anomalies
  • Severe maxillary/mandibular disproportion (but only if the parents are concerned, otherwise wait until the mixed dentition stage)

Types of occlusal problem to refer in the mixed dentition:

  • Anterior or posterior crossbites with associated mandibular displacement
  • Class III in the mixed dentition
  • Class II/I malocclusion where there is an underlying skeletal II pattern. Most functional appliances are easiest to wear when the upper first premolars are fully erupted. Such a patient entering his or her pubertal growth spurt should be seen without delay
  • Asymmetry in the pattern of tooth eruption (especially upper central incisors)
  • Severely hypoplastic/carious first molars of poor long-term prognosis
  • Lack of palpable canine bulges buccally at 10-12 years of age indicating palatal impaction
  • Hypodontia (missing teeth); supernumerary teeth
  • Submerged deciduous molars; impacted first permanent molars
  • Periodontal problems caused by severely ectopic tooth position
  • Severe crowding of incisors

Types of occlusal problem to refer in the permanent dentition:

  • All other malocclusions